Individual
DR. TIMOTHY JOHN SULLIVAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4403 HARRISON BLVD., STE 4640, OGDEN, UT 84403-3304
(801) 387-4850
(801) 387-4855
Mailing address
4403 HARRISON BLVD., STE 4640, OGDEN, UT 84403-3304
(801) 387-4850
(801) 387-4855
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
037913
GA
207KA0200X
Allergy Physician
Primary
8263858-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00570996C
—
GA
05
—
00570996F
—
GA
Enumeration date
06/08/2005
Last updated
06/03/2015
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